Multidisciplinary survey on use of feeding tubes in head and neck cancer patients undergoing chemoradiotherapy in Germany-the SUFEETUBE project

Anastassia Löser; Alexander Fabian; Alexander Rühle; Alexander Thieme; Andrea Baehr; Lukas Käsmann; Inga Zwaan; Birte Kahle; Tamer Soror; Ameya Kunte; Niloufar Seyedi; Maxim Kebenko; Christoph Seidel; Friederike Dierks; Linda Krause; Karl-Ludwig Bruchhage; Dirk Rades

doi:10.1007/s00066-024-02206-w

Multidisciplinary survey on use of feeding tubes in head and neck cancer patients undergoing chemoradiotherapy in Germany-the SUFEETUBE project

Strahlenther Onkol. 2024 Feb 21. doi: 10.1007/s00066-024-02206-w. Online ahead of print.

Authors

Anastassia Löser¹, Alexander Fabian², Alexander Rühle^{3

4}, Alexander Thieme⁵, Andrea Baehr⁶, Lukas Käsmann⁷, Inga Zwaan⁸, Birte Kahle⁸, Tamer Soror⁸, Ameya Kunte⁹, Niloufar Seyedi⁹, Maxim Kebenko¹⁰, Christoph Seidel¹¹, Friederike Dierks¹¹, Linda Krause¹², Karl-Ludwig Bruchhage¹³, Dirk Rades⁸

Affiliations

¹ Department of Radiotherapy, University Medical Center Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany. anastassia.loeser@uksh.de.
² Department of Radiation Oncology, University Hospital Schleswig-Holstein/Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
³ Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany.
⁴ Department of Radiation Oncology, University of Leipzig Medical Center, Stephanstr. 9a, 04103, Leipzig, Germany.
⁵ Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
⁶ Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
⁷ Clinic and Polyclinic for Radiotherapy and Radiooncology, LMU Clinic, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
⁸ Department of Radiotherapy, University Medical Center Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
⁹ Department of Stem Cell Transplantation, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
¹⁰ Department of Hematology and Oncology, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany.
¹¹ Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany.
¹² Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
¹³ Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany.

PMID: 38381142
DOI: 10.1007/s00066-024-02206-w

Abstract

Background and objective: Data on enteral tube feeding in head and neck cancer (HNC) patients undergoing chemoradiotherapy vary considerably between German institutions. This survey aims to investigate the management of feeding tubes in an interdisciplinary context across Germany.

Materials and methods: Between December 2022 and May 2023, 70 participants (42 radiation oncologists, 12 medical oncologists, 14 head and neck surgeons, and 2 physicians covering several specialties) responded to our web-based survey. In addition to the type of institution (university hospital, private practice, etc.), their age, and professional experience (in years), participants were asked several questions on the indication and institutional policy for tube placement and management (prophylactic/reactive nasogastric or gastrostomy tube). All questions were mandatory single- or multiple-choice questions, while additional comments were possible by email.

Results: Most participants were employed at a university hospital (n = 52; 74.3%) and came from a radiation oncology background (n = 42; 60%). Fifty-four contributors (77.1%) reported that no nutritional risk screening prior to chemoradiotherapy was routinely performed, and 71.4% (n = 50) stated that no standardized protocol was used at the institution to set the indication for tube placement. Generally, policies and methods of tube feeding vary considerably between the individual institutions and specialties. However, the majority (n = 56, 80%) recommended a prophylactic percutaneous enteral gastrostomy (PEG) tube to their patients before chemoradiotherapy. Still, there was no consistent trend regarding the approach for reactive tube feeding.

Conclusion: The policies and methods of tube feeding vary considerably between the individual institutions and specialties in Germany. In the era of individualized medicine, uniform protocols are difficult to establish. However, a baseline nutritional risk screening could simplify decision-making in clinical practice.

Keywords: Dysphagia; Gastrostomy tube; Malnutrition; Mucositis; PEG.